Specimen Required

Specimen Minimum Volume

Specimen Stability Information

Reject Due To

Hemolysis

Mild OK; Gross reject

Lipemia

Mild OK; Gross reject

Icterus

Mild OK; Gross reject

Other

NA

Clinical Information

Several antineuronal and glial autoantibodies are recognized
clinically as markers of a patient's immune response to specific
cancers (paraneoplastic autoantibodies). Seropositive patients
present with neurologic symptoms and signs in more than 90% of
cases. The cancers are most commonly small-cell lung carcinoma,
ovarian (or related mullerian) carcinoma, breast carcinoma,
thymoma, or Hodgkin lymphoma. The cancers may be new or recurrent,
are usually limited in metastatic volume, and are often occult by
standard imaging procedures. Detection of the informative marker
autoantibodies allows early diagnosis and treatment of the cancer,
which may lessen neurological morbidity and improve survival.

Serum is the preferred specimen for paraneoplastic
autoantibodies. However, cerebrospinal fluid (CSF) results are
sometimes positive when serum results are negative (especially for
CRMP-5 and other inflammatory central nervous system autoimmunity).
Additionally, CSF is more readily interpretable because it
generally lacks the interfering nonorgan-specific antibodies that
are common in the serum of patients with cancer. Because
neurologists typically perform spinal taps in these patients, we
recommend that CSF be submitted with serum, either for simultaneous
testing or to be held for testing only if serum is negative.

CRMP-5-IgG Western blot is also performed by specific request
for more sensitive detection of CRMP-5-IgG. Testing should be
requested in cases of subacute basal ganglionic disorders (chorea,
Parkinsonism), cranial neuropathies (especially loss of vision,
taste, or smell), and myelopathies.

Reference Values

NEURONAL NUCLEAR ANTIBODIES

Antineuronal Nuclear Antibody-Type 1 (ANNA-1)

<1:2

Antineuronal Nuclear Antibody-Type 2 (ANNA-2)

<1:2

Antineuronal Nuclear Antibody-Type 3 (ANNA-3)

<1:2

Anti-Glial/Neuronal Nuclear Antibody-Type 1 (AGNA-1)

<1:2

NEURONAL AND MUSCLE CYTOPLASMIC ANTIBODIES

Purkinje Cell Cytoplasmic Antibody, Type 1 (PCA-1)

<1:2

Purkinje Cell Cytoplasmic Antibody, Type 2 (PCA-2)

<1:2

Purkinje Cell Cytoplasmic Antibody, Type TR (PCA-TR)

<1:2

Amphiphysin Antibody

<1:2

Collapsin Response-Mediator Protein-5 Neuronal (CRMP-5-IGG)

<1:2

Neuron-restricted patterns of IgG staining that do not fulfill
criteria for amphiphysin, ANNA-1, ANNA-2, ANNA-3, AGNA-1, PCA-1,
PCA-2, PCA-Tr, or CRMP-5-IgG may be reported as "unclassified
antineuronal IgG." Complex patterns that include non-neuronal
elements may be reported as "uninterpretable."

Interpretation

Antibodies directed at onconeural proteins shared by neurons,
glia, muscle, and certain cancers are valuable serological markers
of a patient's immune response to cancer. They are not found in
healthy subjects, and are usually accompanied by subacute
neurological symptoms and signs. Several autoantibodies have a
syndromic association, but no autoantibody predicts a specific
neurological syndrome. Conversely, a positive autoantibody profile
has 80% to 90% predictive value for a specific cancer. It is not
uncommon for more than one paraneoplastic autoantibody to be
detected, each predictive of the same cancer.

In patients with a history of tobacco use or other lung cancer
risk, or if thymoma is suspected, PAVAL / Paraneoplastic
Autoantibody Evaluation, Serum is also recommended.